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Comparison of Nursing Theory: Grand Theory-The Self-Care Deficit and middle-level theory – the peaceful end of life


A nursing theory is a coherent of concepts, descriptions, associations, and expectations or propositions developed to provide a connecting framework or from other disciplines and a scheme derived from purposeful, logical assessment of spectacles by scheming quantified inter-relationships between perceptions for the tenacities of unfolding elucidation, expecting, or advocating. Two principal approaches are used for developing theories: 1) deductive cognitive and 2) inductive cognitive. Nursing philosophers practice both of these approaches in their method development, and these assumptions are made for professional nursing practices.

A theory is “an innovative and complicated configuring of thoughts that develops an unsure, decided, and efficient opinion of occurrences.” The prime tenacity of nursing philosophy is to improve the course and proficient training of nursing. Nursing models are encompassed as a fragment of innovative nursing schooling curriculum. Diverse ideas have different perceptions and senses; conversely, in nursing health care practice, all these theories have an active role in describing the fundamental philosophies and notions in simple techniques. Examples of these principles are as Dorothy Orem’s Self-Care Deficit Theory, which includes in grand theory concepts, as another theory Roland and Moore’s ––level approach to the peaceful end of life. Both established theories are used to enhance nursing education and practices(McEwen & Wills, 2002).

Orem’s model emphasizes on an individual’s skill implementation on self-care to sustain life and well-being. Nurses deliver care concluded performance, prominent, supportive, training, or atmosphere management enhances personal growth. Grand theory as self-care deficit comes under the umbrella of a school of thought of need ideas. Grand plans are multifaceted and all-encompassing in range and can integrate others’ further philosophies. Based on these perceptions, grand theory embraces miscellaneous conducts of programming in nursing spectacles. Middle-level theory, as the peaceful end of life as compared to Grand theory, focuses on more precise perceptions and incorporates a narrower facet of the real world. Conceptions are comparatively practical and operationally distinct. The curriculum of nurses identified medium array theory as one of the medium levels of information expansion, and perception has full recognition for the essential progress level arguments backing nursing rehearses(Shah, 2015).


Grand theory, such as the self-care deficit theory, is the most extensive philosophy in clinical nursing practices. The aim of Orem was to describe Nursing’s apprehensions and nursing’s objectives. From the nurses’ point of view, she discussed individual requirements for self-care, which the nurse must deliver to maintain life and health retrieval from a disease. To overwhelm the social restrictions is a primary aim of nursing. Furthermore, Orem’s theory also explains that self-care is executed to sustain life and well-being. Also, she enlightens on humans monitoring function that design the outline of planned activities such as additional actions, including care with the determination to encounter needs. Henceforth, concepts focused on the person’s requirement of self-care from which the nurse can achieve specific activities to endorse health care and well-being. Additionally, she explains her philosophy as individuals divided into two groups: one who needs care and the other is a care provider (McEwen & Wills, 2002).

Moore and Ruland designed the peaceful end-of-life concept as the middle range theory established from the typical standards of health care for the peaceful end of life. A group of nurses developed the level of health care in Norway. This level of care was on a gastroenterological unit where half of the patients were identified with cancer, and fighting the fatal disorder was on a routine basis. The peace full end of life theory encompasses the dominant perception, which is the notion grounded on these thoughts like being free of pain, a capability of comfort, the existence of peace, a presence of close to your significant others, and feelings of dignity and respect. Like every other middle-range theory, the peaceful end of life also discussed reasonably testable and explicit occurrences by testifying what the portents are, why they occur, and how they happen. In addition, this theory can also provide the framework for the understanding of the code of conduct, circumstances, and occasions (Moorish, 2011).

Contextual of the theorists:

Dorothea Orem (1914 – 2007) was born in Baltimore, Maryland, after graduating from Seton High School in 1931; Orem earned a B.S. in Nursing Education in 1939 at the Catholic University of America and did an M.S. in nursing in 1945. She received her advanced degrees, and this education permitted her to work as director of the Providence Hospital School of Nursing in Detroit, where she also taught biological disciplines and nursing. Orem was an Assistant and Associate Professor, then promoted to the post of Dean of School Nursing at Catholic University America. Orem’s book, which has the title “guidelines for developing curricula for the education of Practical Nursing,” was underpinning of effort. In 1971, wrote another book titled “Nursing: Concepts of Practice,” in which her experience of work grounded in outline results in her theory of nursing in grand philosophy, the self-care Deficit Theory of nursing. Orem authored other books, international speakers, and associations such as Georgetown University and Illinois Wesleyan give her honorary degrees. Like Sigma Theta Tau, the National League for Nursing and the American Academy of Nursing were honored to her. Her attentiveness to the nursing concept was indignant when her professional colleagues assigned her to design a course for applied nursing in the Department of Health, Education, and Welfare in Washington, DC. Nurses will recall her as one of the innovators of nursing philosophy(McEwen & Wills, 2002).

Philosophers Cornelia M. Ruland and Shirley M Moore established the concept of the peaceful end of life as the middle-range theory. In 1998, Ruland earned a Ph.D. Nursing from Case Western Reserve University, Cleveland, Ohio. Presentable, she was appointed as a Director of The Center for Shared Decision-Making and Nursing Research at Rikshopitalet University Hospital in Oslo, Norway. Side by side, she got the appointment as an assistant faculty at the Department Of Biomedical Informatics at Columbia University in New York. In addition to this, she worked as a primary researcher in numerous research projects and has received many awards for her excellent work.

The second philosopher of this theory is Shirley M. Moore; in 1990, she earned degrees in mental health nursing and psychiatry. Furthermore, Moore received her Ph.D. in nursing discipline from the University of Western Reserve, Cleveland, Ohio. She educated nursing theory and science to the entire level of nursing scholars. Moore also demeanors exploration and philosophy improvement in the retrieval of cardiac procedures and has helped in the expansion and publication of numerous models. Both nurses have vast experience in the field of critically ill patients and have appeared in various seminars and post-graduate training programs on this cluster of patients. Philosophers recognized a necessity for clinical guidance, delivery of health care for unsympathetically hostile patients, and improvement in the quality of attention. As concerns of the above thoughts, Ruland and Moore establish a concept for “The Peaceful End of Life”(Ruland & Moore, 1998).

Rational Keystones of the theories:

The Self-Care Deficit Nursing theory is an extremely established formal theoretical structure of nursing, and the concept emphasizes on the individual as a cause. In addition to these, Orem’s Self-Care Deficit Nursing Theory ontology is the school of thought of modest practicality. However, she refused that any specific philosopher deliver the ground for the Self-Care Deficit Nursing Theory. Orem has shown widespread interest in numerous theories, while she mentioned merely Parson’s framework of social movements and Von Bertalanffy’s structure concept (McEwen & Wills, 2002).

The peaceful end of life is grounded in critically ill patients. They are predictable to death within six months or less. Those patients who have the fatal disease no longer desire health care procedures carried on them in the hopefulness of recovery. They accepted the reality of the real world associated with their death and were ready to die with superlative experience for them and their importance to others and their blood relations. As a result, a doctor does not give attention to critically ill patients, and it depends on the nurses how they show their expertise and ethics to their dying process and signs. The nurse needs to recognize the intricacy of taking care of a terminally hostile patient and how they can participate in a nonviolent termination of life (Ruland & Moore, 1998).

Major assumptions, concepts, and relationships

Orem‘s philosophy has the flexibility to fit the time according to changes according to the most noticeably in the theory of the person as well as the nursing system. Mostly, the real concept of Orem’s theory relies hugely on she description of three integrated philosophies such as self-care, self-care deficit, and nursing health care system; this impression of nursing health systems encircles a broad external vision of philosophy and comprises the theory of self-care deficit. The notion of self-care is a part of the self-care deficit concept. Orem’s theory explains encounter patterns as Nurses comprehend sculpture from side to side, which the consultant of nurses’ contribution focused back to individuals with disabilities, which makes them extraordinary essential care to fulfill the desire for self-care.

The intellectual contribution of a nurse in the health care of the person gains from the physician. In Orem’s concept, Humans are described as “males, females, and kids wanted for both individually or as community units” and “material objects” for nurses and others involved who deliver direct health care. Our circumstance has chemical, biological, and physical structures, adding to these domestic cultural traditions and society. Health is the presence of physical and functional sound. She also describes in her theory that the health condition that encircles together the health of persons and groups, and humanoid health is the capacity to reveal on its own, to symbolize practices, or to interconnect with others. Orem’s theory provides a basis for research for various additional philosophies. Associations are supporting evidence of Orem’s principle is the faith that persons involved in constant communiqué and swapping between themselves and their atmospheres persist them to alive and utility. The supremacy of individuals to perform consciously is applied to classify needs and to make desired decisions.

The peaceful end of life includes initial impressions such as 1) without aches, 2) Feeling relief, 3) Feeling self-respect and admiration, 4) Presence in harmony, and 5) Being near to your important others. Further explanations of the pain are unusual sensations associated with tissue damage, while comfort is the relief from discomfort, and dignity and respect are valued and have not uncovered any other issue that creates an arrogant attitude in persons. And to be free from anxiety. In addition to dangerous aspects chosen as valuable to others(Ruland & Moore, 1998).


Various universities and institutions of nursing grounded courses on Orem’s concept: Georgetown University School of Nursing, Oakland University School of Nursing, The University of Missouri, Columbia, and the University of Florida, Gainesville. Hospitals in numerous capacities of the country have initiated nursing health care on Orem’s model, and it has applied to an out-patient care situation. In addition to these health circumstances, such as stiffness, digestive and urinary diseases. Capacities of training in public and private nursing, intensive unit care, cultural traditions impressions, maternal–child care nursing, medical-surgical training nursing, pediatric care nursing, peri and postoperative nursing care, and kidney dialysis, amongst specialties have applied.

In the peaceful end of life, a concept can apply to any care system or to an individual house. There is no big issue where the person stays; the center of attention care is not to be on treatment. However, the primary goal of care for the patient is based on five pillars: no hurt, relaxation, self-respect and esteem, reconciliation, and loving with substantial others in spite of treating their fatality.


Orem’s theory has a wide spectrum and has some complexity due to three assumptions nested in one concept. Because of this encapsulation of three integral portions of the process it leads to complicated and hard to comprehend overlapping of different philosophies. These vital parts further explain to keep a focus on the patient’s inner feelings from disease, which is prohibited for healthy individuals and from various aspects of societal needs. On the other hand, Roland and Moore’s theory is inadequate in their model in such a way that it does not discuss the diversity of culture and norms towards end-of-life care. For example, some cultures believe that the end of life is a very personal matter. The weakness of the theory is that it needs more research to support the concept.


At the end of a comparison made for both methods, conclude views such as both concepts are clear to improve best patient health care, increase the worth of nursing in a medical profession, and progress towards better communiqué among nurses. Orem gives a concept of self-care capacities of an individual to sustain lifespan, well-being, or disease. On the other hand, the Roland and Moore model describes the peaceful end of life with comfort, dignity and respect, empathy and significant others. This approach can change applicable daily. Both these philosophies are appropriate in a nurse’s clinical practice but with different attitudes. Both philosopher explicitly describes meta paradigms but with a different focus on discussing the theory of the concepts. The primary mutual focus is to establish ideas for enhancing nursing knowledge, training, and clinical expertise. But still, there are certain societal constraints centered on a person, such as time-wasting and applicability to particular circumstances and settings.


McEwen, M., & Wills, E. M. (2002). Theoretical basis for nursing.

Murrish, J. (2011). Development of an End-of-Life Care/Decision Pamphlet in the ICU.

Ruland, C. M., & Moore, S. M. (1998). Theory construction based on standards of care: a proposed theory of the peaceful end of life. Nursing Outlook, 46(4), 169–175.

Shah, M. (2015). Compare and Contrast of Grand Theories: Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model. INTERNATIONAL JOURNAL OF NURSING, 5(1).



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